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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-97764

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1. WellPoint Health Networks WELLPAC

    1 WellPoint Way T2-1A6
    Thousand Oaks, CA 91362
    Fax: 0-
    Email: Susan.Nagy@wellpoint.com

2. Date: 10/15/2003

3. FEC Committee ID #: C00197228 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Blue Cross & Blue Shield United of Wisconsin Political Action Committee
401 W. Michigan St.
Milwaukee, Wisconsin 53201
Relationship: affiliated

Custodian of Records:

Nancy Thompson
1 WellPoint Way T2-1A6
Thousand Oaks, CA 91362
Title: Executive Assistant
Phone # (805) 557-6787

Treasurer:

Callen M. Lockett
1 WellPoint Way T2-1A6
Thousand Oaks, California 91362
Title: VP Public Affairs
Phone # (805) 557-6888

Designated Agent(s):

Susan Nagy
1 WellPoint Way T2-1A6
Thousand Oaks, California 91362
Title: Manager
Phone # (805) 557-6788

Banks or Depositories

Bank of America
P.O. Box 27128
Concord, California 94520

Signed: Callen M. Lockett
Date Signed: 11/20/2002
Official Committee FAX: 0-

FORM TEXT

(End FEC FORM 1)

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